The present invention relates generally to surgical apparatus and procedures. More particularly, it relates to methods and apparatus for stripping or removing veins, such as, varicose and saphenous veins, from a venous system of a patient.
Varicose veins are typically found in the limbs of the lower portion of a human body. These veins have usually lost their ability to carry blood back to the heart and blood often accumulates in these veins. As a result, the veins may become swollen, distorted, dilated, elongated, and prominent.
A number of factors can contribute to the development of varicose veins, including heredity, obesity, posture, standing or sitting for a long periods of time, hormonal shifts, and excessive heat. Varicose veins may cause patients to experience various symptoms, such as aching, burning, swelling, cramping, and itching, while more serious complications of varicose veins can include thrombophlebitis, dermatitis, hemorrhage and ulcers. If these varicose veins are not treated, blood clots may form in the vein, and phlebitis or inflammation of the inside lining of the vein may occur. Even absent such symptoms, many patients seek medical treatment of varicose veins for cosmetic reasons.
Various approaches have been developed to treat varicose veins. In less complicated cases, elevation of the legs and use of support hosiery may be sufficient therapy to stop or slow the progression of the varicose veins. Alternatively, a technique called xe2x80x9csclerotherapyxe2x80x9d may be used to treat varicose veins. In this procedure, the affected veins are injected with a sclerosing solution, such as sodium tetradecyl sulfate or pilocainol. Approximately one injection of the solution is usually administered for every inch of the affected veins, and multiple injections may be administered during a treatment session. The sclerosing solution causes subsequent inflammation and sclerosis of the veins. The sclerosis results in localized scarring or closure of the veins, which forces rerouting of the blood away from the affected veins.
However, patients usually have to undergo two or more sclerotherapy treatments in order to alleviate the varicose veins to a satisfactory degree. Other fine reddish blood vessels may also appear around the treated area, requiring further injections. Nevertheless, the sclerotherapy technique may not be a permanent or complete solution since the condition of the varicose veins may reoccur within five years.
Sclerotherapy may also have other potential complications, including browning splotches or bruising of the skin, formation of blood clots in the veins, inflammation, adverse allergic reactions, ulceration, phlebitis, anaphylactic overdose, ischemia, skin or fat necrosis, and peripheral neuropathy. Furthermore, sclerotherapy cannot be applied to the saphenous vein in the upper thigh region due to the risk of sclerosis of the deep veins. Thus, the sclerotherapy technique is often combined with an operative procedure, such as ligation of a portion of the saphenous vein.
Another technique to treat varicose veins is called stab avulsion phelbectomy with hooks. In this technique, one or more incisions are made in the skin of a patient, and a hook is inserted into the incision to grip or hook the veins to be removed. When the veins are grabbed, the veins are pulled though the surgical incision and severed. However, this procedure usually requires two surgeons to perform the procedure and takes about 2-3 hours. In addition, this procedure usually requires multiple incisions in the patient in order to hook the affected veins. Furthermore, it is often difficult to completely remove the entire affected veins using this procedure.
Varicose veins can also be removed by a procedure commonly referred to as xe2x80x9cstripping.xe2x80x9d To remove a saphenous vein using a traditional stripping procedure, a large incision is made near the groin area of a patient and the saphenous vein is separated from the femoral vein. The saphenous vein is also usually dissected near the lower portion of the leg. Multiple large incisions are made along the leg in order to sever and ligate the tributary veins of the saphenous vein. A vein stripper, such as a wire, is then inserted into the lumen of the saphenous vein. The wire is then advanced through the saphenous vein and tied to the lower end of the vein. The wire is then removed top through the groin incision to extract the vein. After the saphenous vein is completely removed from the leg, the large incisions along the leg are closed.
However, this striping procedure is usually painful and often requires overnight hospitalization. In addition, numerous incisions are usually required to remove the saphenous vein and often leave permanent unsightly scars along the leg of a patient. Additionally, the large incisions create a risk of infection to the patient and may not heal properly, especially patients who have poor circulation in their extremities. There are also associated complications with this technique, such as, for example, blood loss, pain, infection, hematoma, nerve injury, and swelling.
In view of the above, the present invention provides methods and apparatus for stripping or removing undesired veins, such as, varicose and saphenous veins, in a venous system of a patient. The apparatus and methods of the present invention provide an efficient and minimally intrusive procedure to remove the undesired veins. The apparatus further allows a surgeon to introduce fluid, such as saline mixed with a local anesthetic, to irrigate the tissue where the vein has been extracted during the surgical procedure. The apparatus and procedures of the present invention also allows the undesired veins to be completely removed with minimal scarring.
One method of removing undesired veins in accordance with the present invention includes the steps of inserting a surgical instrument into a lumen of the vein, advancing the surgical instrument to a desired point along the vein, and attaching the distal end of the vein to the surgical instrument. The method also includes the steps of extracting the surgical instrument to cause the vein to separate from its surrounding tissue, and supplying fluid through the instrument into the tissue where the vein has been extracted.
One surgical apparatus for removing undesired veins in accordance with the present invention includes an elongated member having first and second lumens extending longitudinally therein. The first lumen extends from the proximal end of the elongated member to a first opening at the distal end of the elongated member. The first opening permits fluid to be introduced into the tissue where the vein has been extracted. The second lumen extends from the proximal end of the elongated member to a second opening in the side of the elongated member. The proximal end of the elongated body is coupled to a connector having two separate tubes that communicate with the respective first and second lumen for the injection and removal of fluid. A vein attachment member, attached to the elongated member, is adapted to be secured to the vein.
The invention, together with further attendant advantages, will best be understood by reference to the following detailed description of the presently preferred embodiments of the invention, taken in conjunction with the accompanying drawings. It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory and are intended to provide further explanation of the invention as claimed.